Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported.
a. Percentage of patients who initiated treatment within 14 days of the diagnosis.
b. Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

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Report a total score, and each of the following strata:
Stratum 1: Patients age 13-17 
Stratum 2: Patients age >=18

None

None

There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition.  Treatment of medical problems caused by substance use and abuse places a huge burden on the health care system (Schneider Institute 2001). According to a report from the 2001 National Household Survey on Drug Abuse (NHSDA), an estimated 16.6 million Americans aged 12 or older in 2001 were classified with dependence on or abuse of either alcohol or illicit drugs (7.3 percent of the total population) (Substance Abuse and Mental Health Services Administration 2008). Of these, 2.4 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.2 million were dependent on or abused illicit drugs but not alcohol, and 11.0 million were dependent on or abused alcohol but not illicit drugs (Substance Abuse and Mental Health Services Administration 2008).

American Psychiatric Association (2006)
* Because many substance use disorders are chronic, patients usually require long-term treatment, although the intensity and specific components of treatment may vary over time [I rating]. 
* It is important to intensify the monitoring for substance use during periods when the patient is at a high risk of relapsing, including during the early stages of treatment, times of transition to less intensive levels of care, and the first year after active treatment has ceased [I rating].
* Outpatient treatment of substance use disorders is appropriate for patients whose clinical condition or environmental circumstances do not require a more intensive level of care [I rating]. As in other treatment settings, a comprehensive approach is optimal, using, where indicated, a variety of psychotherapeutic and pharmacological interventions along with behavioral monitoring [I rating].

Michigan Quality Improvement Consortium (2013)
Patient Education and Brief Intervention by Primary Care Physician (PCP) or Trained Staff (eg, RN, MSW) [A rating]
* Assess patient's risk, understanding, and readiness to change. 
* Discuss the relationship of substance use to presenting medical concerns or psychosocial problems. 
* Negotiate goals and strategies for reducing consumption and other change. 
* Involve family members as appropriate. 

Referral
* Refer to a substance abuse health specialist, an addiction physician specialist, or a physician experienced in pharmacologic management of addiction [D rating] 
* Initiate treatment within 14 days 
* Frequent follow-up is helpful to support behavior change; preferably 2 visits within 30 days 
* Also consider referrals to community-based services (eg, Alcoholics Anonymous [AA], Narcotics Anonymous [NA], etc.), or an Employee Assistance Program

Higher score indicates better quality

Schneider Institute for Health Policy, Brandeis University. 2001. Substance Abuse: The Nation's Number One Health Problem. Princeton: Robert Wood Johnson Foundation.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2008. Results from the 2007 National Survey on Drug Use and Health: National Finding. NSDUH Series H-34, DHHS Publication No. SMA 08-4343. Rockville, MD. 

Work Group on Substance Use Disorders, Kleber H.D., R.D. Weiss, R.F. Anton, B.J. Rounsaville, T.P. George, E.C. Strain, S.F. Greenfield, D.M. Ziedonis, T.R. Kosten, G. Hennessy, C.P. O'Brien, H.S. Connery HS, American Psychiatric Association Steering Committee on Practice Guidelines, McIntyre J.S., S.C. Charles, D.J. Anzia, J.E. Nininger, I.A. Cook, P. Summergrad, M.T. Finnerty, S.M. Woods, B.R. Johnson, J. Yager, R. Pyles, L. Lurie, C.D. Cross, R.D. Walker, R. Peele, M.A. Barnovitz, S.H. Gray, J.P. Shemo, S. Saxena, T. Tonnu, R. Kunkle, A.B. Albert, L.J. Fochtmann, C. Hart, D. Regier. 2006. Treatment of patients with substance use disorders, second edition. American Psychiatric Association. Am J Psychiatry 163(8 Suppl):5-82.

Michigan Quality Improvement Consortium. 2013. Screening, diagnosis and referral for substance use disorders. Southfield (MI): Michigan Quality Improvement Consortium.

The initiation visit is the first visit for alcohol or other drug dependence treatment within 14 days after a diagnosis of alcohol or other drug dependence.

Treatment includes inpatient AOD admissions, outpatient visits, intensive outpatient encounters or partial hospitalization.

The new episode of alcohol and other drug dependence should be the first episode of the measurement period that is not preceded in the 60 days prior by another episode of alcohol or other drug dependence.

TBD

Patients age 13 years of age and older who were diagnosed with a new episode of alcohol or drug dependency during a visit in the first 11 months of the measurement period

Equals Initial Population

Patients with a previous active diagnosis of alcohol or drug dependence in the 60 days prior to the first episode of alcohol or drug dependence

Numerator 1: Patients who initiated treatment within 14 days of the diagnosis

Numerator 2: Patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit

Not Applicable

None

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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